WASHINGTON – The number of Hoosiers without health insurance fell 41 percent after the coverage expansion elements of the Affordable Care Act went into effect, according to new federal data.

The 8.1 percent of residents who still lacked insurance last year is now lower than the national 8.6 percent rate, the Census Bureau reported. But Indiana still has a higher share of its population uninsured than do its neighboring states, which expanded their Medicaid programs before Indiana did.

And advocates for the poor are concerned that progress in reducing the share of the population without health care — which is now at a record low nationally — could erode because of actions by the Trump administration and the GOP-controlled Congress.

“The historic progress at reducing the uninsured rate remains at risk,” said Bob Greenstein, president of the Center on Budget and Policy Priorities.

Although GOP efforts to repeal the Affordable Care Act stalled in the Senate this summer, a group of senators are renewing a push to replace the 2010 law with state block grants.

Meanwhile, House conservatives are trying to force a vote on a repeal bill that passed Congress in 2015, but was vetoed by then-president Barack Obama.

And it’s unclear whether a bipartisan effort to shore up the health insurance markets created by the ACA for people who don’t get coverage through an employer or government program will be successful — and whether they can act before insurers have to decide at the end of the month whether to participate.

In addition, the Trump administration has cut back on outreach efforts to help people sign up for coverage. Advertising for the 2018 enrollment period has been slashed, as has funding for groups who provide one-on-one assistance, including helping consumers figure out if they qualify for subsidies.

A spokesman for Eskenazi Health said the Indianapolis health system doesn’t know yet how its federal funding for consumer helpers would be affected. But Eskanazi, which has more than 60 helpers, still plans major outreach efforts for 2018 enrollments starting next month.

Affiliated Service Providers of Indiana, which is the largest recipient of federal funding for consumer helpers, could find out later this week how much they’re getting to support their statewide assistance efforts.

“We’re hopeful the funding level will not significantly change,” said Julia Holloway, who is running ASPI's navigator program, which included staffing a booth at the Indiana State Fair. “We’re already scheduling appointments.”

Holloway said Indiana has made “wonderful progress” in getting people covered. Her group regularly hears from people grateful for helping them get the surgery they needed or being able to treat a sick child, she said.

About 147,000 Hoosiers had coverage through the marketplace at the beginning of the year, most of whom (73 percent) receive subsidies to reduce the cost of premiums. Nearly half also get help paying deductibles and other out-of-pocket expenses.

Insurers are supposed to be reimbursed by the federal government for the subsidies, reducing out-of-pocket expenses. But the Trump administration has not said how long they will continue. The uncertainty was cited by some insurance companies as a reason they will not participate in the Obamacare individual insurance markets next year.

The number of insurance companies selling 2018 plans on Indiana’s marketplace is expected to drop from four to two.

Sen. Lamar Alexander, R-Tenn.(Photo: Associated Press)

Sen. Lamar Alexander, the Tennessee Republican spearheadingthebipartisan effort to stabilize the marketplaces, hopes to pass legislation this month to continue the subsidies through next year. But state insurance regulators and governors who recently testified before Alexander’s health committee urged senators to continue the cost-sharing funding for another two or three years.

An official from Indianapolis-based Anthem, which has pulled out of the Obamacare market in Indiana and other states, is among those scheduled to testify Thursday at the committee’s final hearing on the subject.

Besides the subsidized individual insurance markets, the other main way the ACA expanded coverage was through Medicaid. States, however, were not required to accept federal funding needed to expand the joint federal and state health care program for the poor. Indiana only did so in early 2015 after getting permission for an alternative approach, which requires participants to make monthly contributions to a health account.

The number of Hoosiers without health insurance dropped 14 percent between 2013 and 2014, when the subsidies for individual insurance became available, but before Medicaid eligibility was expanded. In the first year of Medicaid expansion, the number of insured declined an additional 19 percent. The second year of expansion, between 2015 and 2016, the number of uninsured dropped another 16 percent.

The improved economy likely contributed to the drop in the uninsured rate. But states that expanded Medicaid have had much bigger drops than in those that did not.

Buy Photo

Gov. Eric Holcomb speaks during press availability at the governor's residence on March 31.(Photo: Jenna Watson/IndyStar)

Indiana Gov. Eric Holcomb has asked the federal government to make additional changes to Indiana’s alternative Medicaid program, including requiring some recipients to work. About 30 percent of those on that alternative program, called the Healthy Indiana Plan, would have to work at least 20 hours a week, attend school or participate in the state’s Gateway to Work program. The state estimates about one-fourth — or about 33,000 — of those referred to Gateway to Work would choose not to participate and would no longer receive Medicaid benefits.

Critics say a Medicaid work requirement would shift funds away from providing health care while creating a new bureaucracy that will lead to people being denied care without significant increases in employment.

Holcomb argues that increasing participation in the state's Gateway to Work program will encourage Medicaid recipients to be self-sufficient and help them transition to getting their insurance through an employer.

Contact Maureen Groppe at mgroppe@gannett.com. Follow her on Twitter: @mgroppe.